Inspection visit
Health inspection
10 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 10 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review the facility failed to provide a dignity or privacy bag (a urinary
drainage bag holder that restores the dignity of catheterized [insertion of a tube into the bladder to allow
urine to drain for collection] residents by covering urinary drainage bags from the public view) for one of 20
sampled residents (Resident 307) indwelling catheter (a tube that drains urine from the body into a bag
outside the body).
This failure had the potential to result in Resident 307's low self-esteem and privacy being violated.
Findings:
During a review of Resident 307's admission Record (Face Sheet ), indicated Resident 307 was admitted to
the facility on [DATE] with the diagnoses including acute kidney failure (a medical condition in which the
kidneys can no longer adequately filter waste products from the blood), urine retention (the inability to
completely empty the bladder), and benign prostatic hyperplasia (a noncancerous increase in size of the
prostate gland (a gland of the male reproductive system) with lower urinary tract (consists of kidneys,
ureters, bladder and the urethra) symptoms.
During a review of Resident 307's Physician Orders, dated 9/22/2023, the Physician Orders indicated,
Resident 307 had an order for an indwelling catheter for urinary retention.
During a review of Resident 307's History and Physical (H&P) dated 9/23/2023, the H&P indicated,
Resident 307 did not have the capacity to make decisions.
During a review of Resident 307's Minimum Data Set(MDS - a standardized assessment and care
screening tool), dated 10/2/2023, the MDS indicated, Resident 307 required partial to moderate assistance
with eating, oral hygiene, toileting, positioning from sitting on the side of the bed to lying flat on the bed, to
move from lying on the back to sitting on the side of the bed with no back support, to come to a standing
position from sitting in a chair, wheelchair or on the side of the bed, to transfer to and from a bed to a chair,
to get on and off a toilet or commode, and walking.
During a concurrent observation and interview on 11/27/2023 at 11:45 am, with Certified Nursing Assistant
(CNA) 4, in Resident 307's room, observed Resident 307 had an indwelling catheter without a dignity or
privacy bag covering the indwelling catheter bag. CNA 4 stated Resident 307 does not have a privacy bag
on. CNA 4 stated it was important for Resident 307 to have a dignity/privacy bag to cover the drainage bag
from the public view for privacy and residents 'dignity.
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 19
Event ID:
055531
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
During an interview on 11/30/2023 at 10:07 am with Licensed Vocational Nurse (LVN) 1, LVN 1 stated the
dignity bag maintains the resident's privacy. LVN 1 stated the dignity bag should be used at all times. LVN 1
stated after providing care the dignity bag should be placed back over the indwelling catheter bag. LVN 1
stated the dignity bag was used for the resident's well being for privacy and dignity.
During an interview on 11/30/2023 at 12:44 pm with the Director of Nursing (DON), the DON stated all staff
were responsible to ensure Resident 307 had dignity bag over the indwelling catheter drainage bag to
maintain privacy while the resident was up in a chair or in the bed.
During a review of the facility's policy and procedure (P&P) titled, Emptying a Urinary Drainage Bag/Use of
Privacy Bag revised on 11/2010, the P&P indicated to, Place the urinary bag in a dignity/privacy bag when
in bed or wheelchair to ensure resident's privacy is maintained.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 2 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure one of seven sampled resident
(Resident 256) responsible party (RP) was notified when the hemoglobin (a red protein responsible for
transporting oxygen in the blood) dropped significantly to 7.3 grams/deciliter (g/dcl-normal levels 11.6-15)
This failure violated the Resident 256's rights of notification of responsible parties of the care services
provided and had the potential to result in a lack of proper care and treatment.
Findings:
During a review of Resident 256's admission Record (Face Sheet) indicated Resident 256 was admitted to
the facility on [DATE], with diagnoses including iron deficiency anemia (a condition in which blood lacks
adequate healthy red blood cells), falls, and dysphagia (difficulty in swallowing).
During a review of Resident 256's Minimum Data Set (MDS - a standardized assessment and care planning
tool) dated 11/19/2023, the MDS indicated Resident 256 was severely cognitively impaired (a person who
has trouble remembering, learning new things, concentrating, or making decisions).
During a review of Resident 256's history and physical (H&P) dated 11/16/2023, the H&P indicated
Resident 256 does not have the capacity to make decisions.
During a review of Resident 256's care plan (CP) dated 11/28/2023, the CP indicated Resident 256 was at
risk for low hemoglobin. The CP indicated the facility will educate the family on signs and symptoms of iron
deficiency anemia.
During a review of Resident 256's Change of Condition form (COC) dated 11/25/2023, the COC indicated
Resident 256 had a low hemoglobin level of 7.3 (normal levels 11.6-15). The COC indicated that Resident
256 responsible party (RP) was not notified.
During an interview on 11/28/2023 at 9:30 a.m. with the RP, the RP stated no one from the facility called to
notify that Resident 256 hemoglobin blood levels have dropped.
During an interview on 11/28/2023 at 9:41 a.m. with the Registered Nurse (RN) 1, RN 1 stated she did not
notify Resident 256's RP of low hemoglobin level of 7.3 g/dcl. RN 1 stated it was important to notify the RP
so they will be aware of Resident 256 condition. RN 1 stated it should be documented on the COC that the
RP was notified but it was not done.
During an interview on 11/30/2023 at 12:43 p.m. with the Director of Nurses (DON), the DON stated any
change of condition of a resident including a low hemoglobin should be reported to Resident 256's
responsible party and documented in the medical record. DON stated it was important to inform RP of any
change in condition, so they were aware of resident's condition and plan of care.
During a review of the facility policy and procedure (P&P) titled Change in a Resident's Condition or Status
dated 2/2021, the P&P indicated the facility will promptly notify the RP of changes in the resident
medical/mental condition and or status. The P&P indicated except in medical emergencies, the RP will be
notified within twenty-four hours of change in condition.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 3 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0580
During a review of the facility P&P titled Resident Rights dated 12/2016, the P&P indicated that the resident
has the right to be informed of his or her medical condition and of any changes in his or her condition.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 4 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
Based on interview and record review, the facility failed to develop a comprehensive care plan (a
resident-specific plan with defined clinical goals and interventions used to manage identified medical issues
or other areas of concern) regarding the use of Depakote (a medication used to treat mood problems) to
treat a behavioral problem of sudden outbursts of anger in one of five residents sampled for unnecessary
medications (Resident 74.)
This failure to develop and implement a care plan with measurable objectives for the use of Depakote may
result in not meeting Resident 74's medical, nursing, and mental and psychosocial needs to maintain or
attain Resident 74's highest practicable, physical, mental, and psychosocial well-being.
Findings:
During a review of Resident 74's admission Record (Face Sheet), indicated Resident 74 was admitted to
the facility originally on 7/1/23 with diagnosis including unspecified dementia (loss of memory, language,
problem-solving and other thinking abilities) with other behavioral disturbance.
During a review of Resident 74's Order Summary Report, dated 11/29/23, the Order Summary Report
indicated the physician prescribed the following medication on the following date:
1.On 10/25/23 - Depakote 125 milligrams (mg - a unit of measure for mass) by mouth two times a day for
mood stabilizer manifested by sudden outburst of anger.
During a review of Resident 74's available care plans, last revised October 2023, indicated there were no
care plans to address Resident 74's behavioral issues of sudden outbursts of anger that identified the use
of Depakote as a targeted intervention.
During an interview on 11/29/23 at 11:25 a.m. with the Director of Nursing (DON), the DON stated that the
facility was responsible to create a new care plan concerning any medications used to treat behavioral
issues. DON stated the facility failed to create a new care plan regarding the use of Depakote to treat the
behavioral issue of sudden outbursts of anger for Resident 74. DON stated the care plan creates the
therapeutic goal of the facility to treating the resident's problem and there was a risk that the resident's care
may not be reviewed and revised as needed without a care plan to establish therapeutic goals leading to a
possible decrease in physical, mental, and psychosocial well-being.
During a review of the facility's policy and procedure (P&P) titled, Care Plans, Comprehensive
Person-Centered, dated December 2016, the P&P indicated, The comprehensive, person-centered care
plan will include measurable objectives and timeframes; describe the services that are to be furnished to
attain and maintain the resident's highest practicable physical, mental, and psychosocial well-being; reflect
treatment goals, timetables and objectives in measurable outcomes .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 5 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview, and record review, the facility staff failed to ensure resident received radiation treatments (cancer
treatment that uses radiation (usually high-powered X-rays) to kill cancer cells.) for basal cell carcinoma
(type of skin cancer) of the left eye for one of seven sampled residents (Resident 48) by:
Residents Affected - Few
1.Failing to send Resident 48 to the correct outpatient department for a scheduled radiation treatment on
11/22/2023.
2.Failing to provide transportation for an outpatient scheduled radiation treatment on 11/27/2023.
These failures resulted in a delay of services/treatments and the potential for Resident 48 to be exposed to
radiotoxicity for back-to-back radiation treatments.
Findings:
During a review of Resident 48's admission Record (Face Sheet), indicated Resident 48 was admitted to
the facility on [DATE]with diagnoses of major depressive disorder (a mood disorder that causes a persistent
feeling of sadness and loss of interest), basal cell carcinoma of the skin, and impaired vision of the left eye.
During a review of Resident 48's Minimum Data Set (MDS - a standardized assessment and care screening
tool) dated 11/9/2023, the MDS indicated Resident 48 has severe cognitive impairment (when a person has
trouble remembering, learning new things, concentrating, or making decisions).
During a review of Resident 48's History and Physical (H&P) dated 5/9/2023, the H&P indicated Resident
48 had a lesion (an abnormal change in structure of an organ or part due to injury or disease) of the left
upper eyelid and cancer (abnormal tissue growth) of the left eyelid.
During a review of Resident 48's care plan (CP) dated 11/20/2023, the CP indicated Resident 48 was
receiving radiation therapy for basal cell carcinoma of the left eye. The CP indicated the facility will assist
with transportation arrangements to radiation appointments.
During a review of Resident 48's Physician Order dated 11/20/2023, indicated Resident 48 had an
appointment with radiology (a branch of medicine that uses imaging technology to diagnose and treat
disease) treatment appointment on 11/22/2023 at 10:45 a.m. at the General Acute Care Hospital (GACH)
and transportation to be provided by the Social Worker (SW). Resident 48's physician order was for an
appointment in the radiation department.
During a review of Resident 48's Social Service Progress Note dated 11/14/2023, indicated the SW set up
transportation for Resident 48 to go to the radiology department at the GACH on 11/22/2023.
During a review of Resident 48's transportation request dated for 11/22/2023, the transportation request
indicated Resident 48 had a request to a radiology appointment, not a radiation appointment.
During a review of Resident 48's radiation treatment calendar for November 2023, the calendar indicated
Resident 48 had radiation treatments scheduled on 11/22/2023, 11/27/2023 and 11/30/2023 at the GACH.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 6 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0684
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
During a review of Resident 48's Nurses Progress Note dated 11/22/2023 at 11:55 a.m., indicated Resident
48 came back from his appointment and the charge nurse (CN) received a call from the radiation oncology
department at the GACH and stated Resident 48 did not show up for his radiation treatment appointment.
The Nurses Progress Note indicated Resident 48 was taken to the radiology department and not the
radiation department by the facility escort. The Nurses Progress Note indicated Resident 48 will need to
add another treatment to complete the five radiation sessions.
During a review of Resident 48's Psychology notes dated 11/23/2023, the Psychology note indicated
Resident 48 expressed frustration about not going to his radiation appointment.
During a review of Resident 48's Nurses Progress Note dated 11/27/2023 at 10:56 a.m., indicated there
were issues with transportation and Resident 48 radiation treatment had to be cancelled for 11/27/2023.
During an interview on 11/28/23 at 12:30 p.m. from the GACH radiation department staff member (SM), the
SM stated Resident 48 missed his radiation appointments on 11/22/2023 and 11/27/2023 because the
facility sent him to the wrong department on 11/22/2023 and did not provide transportation for Resident 48
appointment on 11/27/2023.
During an interview on 11/28/2023 at 1:25 p.m. with Licensed Vocational Nurse (LVN) 3, LVN 3 stated
Resident 48 missed his radiation treatment appointment on 11/22/2023 because he was taken to the wrong
department by the facility staff. LVN 3 stated Resident 48 missed his radiation treatment on 11/27/2023
because he did not have transportation. LVN 3 stated it was important for Resident 48 to have his radiation
treatments to improve the condition on his left eye and make it better. LVN 3 stated Resident 48 has basal
cell carcinoma of the left eye.
During an interview on 11/28/2023 at 2:03 p.m. with the Social Worker Assistant (SWA), the SWA stated
Resident 48 missed his radiation treatment appointment on 11/22/2023 because the facility escort took him
to the wrong department.
During an interview on 11/28/2023 at 2:06 p.m. with the facility escort (FE), the FE stated she was told by
the charge nurse (CN) to take Resident 48 to the radiology department on 11/22/2023. FE stated she did
not know Resident 48 was supposed to go to the radiation department.
During an interview on 11/29/2023 at 9:56 a.m. with the SWA, the SWA stated it was the responsibility of
the social service department to set up and confirm transportation for the residents.
During an interview on 11/29/2023 at 11:02 a.m. with the Director of Nurses (DON), the DON stated
Resident 48 orders were entered incorrectly for his radiation treatment appointments. The DON stated it
was important that the order was entered correctly so the resident could make it to his radiation
appointments so his left eye will heal and not affect his eyesight.
During a review of the facility's policy and procedure (P&P) titled Transportation and Appointments dated
12/2008, the P&P indicated the social service department will be responsible for arranging transportation.
During a review of the facility's P&P titled Registered Nurse (RN) job description dated 10/2020, indicated
the RN transcribe telephone, verbal, and telemedicine orders from providers as appropriate. The
Registered Nurse (RN) job description indicated the RN initiates requests for consultations or
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 7 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0684
referrals as requested. The Registered Nurse (RN) job description indicated the RN is to provide oversight
of Certified Nurse Assistants (CNA) and licensed nurses as directed by the DON.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 8 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0756
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart,
following irregularity reporting guidelines in developed policies and procedures.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to act on one recommendation from the consultant pharmacist
(a professional responsible for reviewing each resident's medication profile monthly to identify and report
changes) from 10/5/23 regarding lowering of the dose of esomeprazole (a medication used to treat
stomach acid problems) from twice daily to once daily in one of five residents sampled for unnecessary
medications (Resident 74.)
This failure of failing to respond to recommendations from the consultant pharmacist could have resulted in
Resident 74 receiving a higher than necessary dose of esomeprazole possibly resulting in medication side
effects (a secondary, typically undesirable effect of a drug or medical treatment).
Findings:
During a review of Medication Regimen Review (MRR - a monthly evaluation of the medication regimen of
a resident, with the goal of promoting positive outcomes and minimizing adverse consequences associated
with medication), dated 10/5/23, the review indicated the consultant pharmacist recommended reducing
Resident 74's esomeprazole maintenance dose from 40 milligrams (mg - a unit of measure for mass) twice
daily to 40 mg once daily before breakfast.
During a review of Resident 74's admission Record (Face Sheet) indicated Resident 74 was admitted to the
facility on [DATE] with diagnoses including Gastroesophageal reflux disease ([GERD] a stomach problem
involving the production of too much stomach acid.)
During an interview on 11/29/23 at 11:25 a.m. with the Director of Nursing (DON), the DON stated when
consultant pharmacist makes recommendations regarding a resident's medication therapy, it was the
facility's responsibility to follow up on those recommendations within 30 days. The DON stated the
consultant pharmacist made a recommendation to decrease the dose of esomeprazole for Resident 74 on
10/5/23 but facility staff failed to follow up on the recommendation. The DON stated Resident 74 may have
experienced more side effects than necessary because of their failure to follow up with the physician
regarding the proposed dosage reduction.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 9 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted
professional principles; and all drugs and biologicals must be stored in locked compartments, separately
locked, compartments for controlled drugs.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure that one expired fluticasone/salmeterol
(a medication used to treat breathing problems) inhaler for Resident 22, was removed from the medication
cart in one of two inspected medication carts (Medication Cart 2.)
This failure could have resulted in Resident 22 experiencing preventable episodes of shortness of breath
and troubled breathing possibly leading to hospitalization.
Findings:
During a review of Resident 22's admission Record (Face Sheet), indicated Resident 22 was admitted to
the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD - a lung
disease that causes restricted airflow from the lungs and breathing problems).
During a concurrent observation and interview on 11/28/23 at 1:42 p.m. of Medication Cart 2 with Licensed
Vocational Nurse (LVN) 2, the following medication was found expired:
1.One opened fluticasone/salmeterol inhaler device for Resident 22, with opened date of 10/25/23.
During a review of manufacturer's product labeling, fluticasone/salmeterol inhalers should be discarded one
month after removal from foil pouch.
During a concurrent interview with LVN 2 stated the medication was only good for 30 days once the foil
pack was opened. LVN 2 stated this inhaler was opened on 10/25/23 and would have expired on 11/24/23.
LVN 2 stated this medication was now considered expired, was not safe to administer to Resident 22, and
should have been removed from the medication cart on the day it expired. LVN 2 stated, if expired
medications were not removed from the medication cart, there was a chance they could still be
administered to the resident once they have expired. LVN 2 stated that if a resident was administered an
expired breathing treatment, it could be ineffective which might cause respiratory issues or other medical
complications for the resident possibly resulting in hospitalization.
During a review of the facility's policy and procedure (P&P) titled Medication Storage in the Facility, dated
2008, the P&P indicated, Outdated, contaminated, or deteriorated medications and those in containers that
are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according
to procedures for medication disposal, and reordered from the pharmacy if a current order exists .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 10 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0803
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be
updated, be reviewed by dietician, and meet the needs of the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to honor food preference of one of two sampled
residents (Resident 356) by ensuring vegetables are not overcooked.
This failure had the potential for Resident 356 to not receive their nutritional needs and food preferences.
Findings:
During a review of Resident 356's admission Record (Face Sheet), indicated Resident 356 was admitted to
the facility on [DATE] with diagnoses including atrial fibrillation (irregular and often rapid heartbeat that can
cause poor blood flow), difficulty in walking, hemiplegia (paralysis on one side of the body), and
hemiparesis (weakness on one side of the body) following a cerebral infarction (damage to the brain from
interruption of its blood supply) and diabetes (a condition in which the body fails to metabolize (process)
glucose (sugar) correctly).
During a review of Resident 356's Minimum Data Set ([MDS] a standardized assessment and care
screening tool) dated 11/20/2023, the MDS indicated Resident 356 had an intact cognition (ability to think
and reason) and required substantial assistance with bed mobility, toileting, bathing, and dressing.
During a review of Resident 356's meal tray ticket dated 11/28/2023, the meal tray ticket indicated Resident
356 was on a regular, controlled carbohydrate diet ([CCHO]diet that limits or controls consumption of
carbohydrate to help keep blood sugar levels stable), liked green beans, spinach and disliked overcooked
vegetables.
During a subsequent interview on 11/28/23, at 1:45 p.m. and on 11/30/2023, at 10:46 a.m. with Resident
356, Resident 356 stated vegetables served were always overcooked. Resident 356 stated the green peas
on the lunch tray was not tasty and overcooked. Resident 356 stated an unnamed kitchen personnel came
and asked her about her food preferences and was aware of her dislike for overcooked vegetables.
Resident 356 stated she felt helpless and frustrated for not getting the food she wanted and how vegetables
were cooked and prepared.
During an observation on 11/28/2023, at 1:30 p.m. test tray for lunch consisted of chicken, green peas, and
diced red potatoes. Observed neon green colored peas, mushy and overcooked.
During an interview on 11/30/2023, at 8:30 a.m. with Dietary Supervisor (DS), DS stated she asked
Resident 356 about her food preferences and Resident 356 had mentioned to her about her dislike for
overcooked vegetables. DS stated Resident 356 would not eat and get disappointed if her vegetables were
overcooked because her food preference was not followed.
During a review of facility's policy and procedure (P&P) titled Food Preferences undated, the P/P indicated
resident's food preferences will be adhered to within reason.
During a review of facility's P&P titled Food and Nutrition Services revised 10/2017, the P&P indicated
residents are provided with a nourishing, palatable and well-balanced diet that will meet his
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 11 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0803
or her nutritional, special dietary needs and preferences.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 12 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interview, and record review, the facility failed to handle and store food in a sanitary
manner to prevent growth of microorganisms (an organism that can be seen only through a microscope)
that could cause food borne illness (food poisoning: any illness resulting from the food spoilage of
contaminated food) for 99 out of 99 total residents in the facility by failure to:
1. Ensure enriched Farina hot wheat cereal have a received date label.
2 Ensure Dietary Aide (DA) 1, DA 2, DA 3, DA 4 and [NAME] 2 did hand hygiene (hand washing ) and don
gloves when handling food during the tray line (a process of preparing and setting food for the residents in
the facility).
3 Ensure ice machine maker door lining was kept clean.
4 Ensure freezer thermometer was calibrated and in working condition.
These failures had the potential for growth of microorganisms (an organism that can be seen only through a
microscope) that could cause food borne illness (food poisoning: any illness resulting from the food
spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food, as well as
toxins) for 99 out of 99 total residents in the facility.
Findings:
1. During the initial facility kitchen tour observation on 11/27/2023 at 8:30 a.m., observed enriched Farina
hot wheat cereal inside the facility food pantry (a room or closet in which food, groceries, and other
provisions and dry goods are kept) was not labeled with received date.
During an interview on 11/27/2023 at 8:53 a.m., with the DA 1 stated there was no received date for
enriched Farina hot wheat cereal that was stored inside the facility food pantry.
2.During a tray line observation on 11/28/2023 at 11:47 a.m., the DA 3 touched the food on the plate with
her fingers without gloves on.
During a tray line observation on 11/28/2023 at 11:53 a.m., the DA 1 reached to the bin to get utensils with
her hands and provided the utensils to [NAME] 1 without wearing gloves.
During a tray line observation on 11/28/2023 at 11:52 a.m., DA 4 reached to the bin to get utensils with her
hands and provided the utensils to [NAME] 1 without wearing gloves.
During a tray line observation on 11/28/2023 at 11:57 a.m., DA 1 touched the food on the plate with her
fingers without gloves on.
During a tray line observation on 11/28/2023 at 12:10 p.m., DA 2 touched the food on the plate with her
fingers without gloves on.
During a tray line observation on 11/28/2023 at 12:15 p.m., DA 1 with oven mitt on both hands and brought
puree green peas without putting gloves.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 13 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
During a tray line observation on 11/28/2023 at 12:29 p.m., DA 3 touched the food cart and the plate inside
the food cart and comes back to the tray line without wearing gloves.
During a tray line observation on 11/28/2023 at 12:37 p.m., DA 4 opened the walk-in refrigerator and took
six butter and place it on the tray without washing hands and wearing gloves.
Residents Affected - Many
During a tray line observation on 11/28/2023 at 12:40 p.m., DA 2 took a plate and put it to the tray line area
without washing hands and wearing gloves.
During an interview on 11/28/2023 at 2:11 p.m. with DA 4, DA 4 stated when doing the tray line preparation,
it was important to wear gloves and wash your hands before and after handling of food for infection control.
During an interview on 11/28/2023 at 2:17 p.m., with DA 1, DA 1 stated all staff from the kitchen must wash
their hands and wear gloves before handling foods in the kitchen for infection control and prevent any food
borne illnesses.
During an interview on 11/28/2023 at 02:21 p.m. with [NAME] 2, [NAME] stated he should have worn
gloves when taking utensils from the bin and handing it to [NAME] 4 who was doing the tray line
preparation for infection control.
During an interview on 11/28/2023 at 2:23 p.m., with DA 2, DA 2 stated staff should wear gloves during tray
line preparation as they were handling food.
3. During a facility kitchen tour observation on 11/27/2023 at 8:48 a.m., observed ice maker machine dirty
around the opening area.
During an interview on 11/27/2023 at 8:50 a.m., with DA 1, DA 1 stated the opening door inside of the ice
machine maker was dirty as evidenced by the paper towel used to wipe the lining inside the ice maker
machine became dirty.
During an interview on 11/28/2023 at 8:30 a.m., with the Dietary Supervisor (DS), DS stated the icemaker
machine must be kept clean to prevent from harboring micro-organisms and for infection control.
4.During an observation on 11/27/2023 at 2:21 p.m., the thermometer inside the facility freezer located
outside the kitchen near the exit of the facility backdoor where the frozen goods are kept was malfunction
and does not provide accurate reading of the temperature inside the freezer.
During an interview on 11/27/2023 at 2:26 p.m. with the DS, DS stated the thermometer inside the freezer
was malfunctioning and not working properly.
During a review of the facility's policy and procedure (P&P) titled Food Handling dated 2018, indicated Food
will be prepared and served in a sanitary manner. All food and nutrition service personnel will wash their
hands prior to handling all food, hands should be washed before and after handling.
During a review of the facility's P&P titled Ice Machine Cleaning Procedure dated 2018, indicated, The ice
machine needs to be cleaned and be sure special attention is paid to cleaning the door molding and the lid
of the machine.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 14 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
During a review of the facility's P&P titled Thermometer Use and Calibration dated 2018, indicated, Food
thermometers are to be used properly and calibrated to ensure accurate temperature reading.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 15 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to observe infection control measures on two of
six sampled residents (Resident 27 and Resident 43) when Certified Nursing Assistant 3 placed a plastic
bag with soiled linens on the fall mat (cushioning pad placed on the floor along the side of the bed that can
reduce injury due to fall) of Resident 43 while providing care to the residents.
Residents Affected - Few
This failure had the potential to result in cross contamination (physical movement or transfer of harmful
bacteria from one person, object, or place to another) and place residents at risk for infection.
Findings:
During a review of Resident 27's admission Record (Face Sheet), indicated the Resident 27 was initially
admitted to the facility on [DATE] and was readmitted on [DATE] with diagnoses including dementia (loss of
cognitive functioning such as thinking, remembering, and reasoning which can affect and interfere with
daily life and activities), and unspecified osteoarthritis (wearing down of the protective tissue at the ends of
the bones which occurs gradually and worsens overtime).
During a review of Resident 27's Minimum Data Set ([MDS] a standardized assessment and care screening
tool) dated 11/2/2023, the MDS indicated the Resident 27 had severely impaired cognitive skills (ability to
learn, remember, understand, and make decision) and required full assistance from staff members with bed
mobility, toileting, personal hygiene, and transfer from bed to wheelchair.
During a review of Resident 43's Face Sheet, indicated the Resident 43 was initially admitted to the facility
on [DATE] and was readmitted on [DATE] with diagnoses including dementia, contracture (shortening and
hardening of muscles, tendons, and other tissue causing deformity and rigidity of joints) of right elbow and
right hand and osteoarthritis.
During a review of Resident 43's History and Physical (H&P) dated 8/16/2023, indicated Resident 43 did
not have the capacity to understand and make decisions because of dementia.
During a review of Resident 43's MDS dated [DATE], the MDS indicated Resident 43 required full
assistance from the staff members with eating, toileting, bathing, dressing, personal hygiene, and transfer.
During a concurrent observation and interview on 11/27/2023, at 10:00 a.m. with Certified Nursing
Assistant (CNA) 3, observed plastic bag of linens was laying on the fall mat of Resident 43. CNA 3 stated
the plastic bag filled with linens was dirty and came from Resident 27 whom she just provided care.
During an interview on 11/29/2023, at 11:06 a.m. with CNA 3, CNA 3 stated she should have taken the bag
of dirty linens from Resident 27 to the hamper as soon as it was wrapped in the plastic bag because there
could be a risk of cross contamination and spread of infection if it was left on the fall mat of Resident 43.
During an interview on 11/29/2023, at 3:01 p.m. with Infection Preventionist Nurse (IPN), IPN stated dirty
linens should be disposed to the proper receptacle and not placed on the floor or floor mat
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 16 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
of another resident to prevent spread of infection.
Level of Harm - Minimal harm
or potential for actual harm
During an interview on 11/30/2023, at 12;44 p.m. with Director of Nursing (DON), the DON stated dirty
linens should be placed in the hamper or receptacle outside the door of a residents' room and should not
be placed on the floor or fall mat because of the risk of contamination and spread of infection.
Residents Affected - Few
During a review of facility's policy and procedure (P&P) titled Linen (Laundry) Management revised
12/2022, the P/P indicated soiled linen should be placed in a designated container to protect residents and
staff from exposure to potentially infectious materials during handling of clean and contaminated linens.
Appendix D: Linen and Laundry Management | Environmental Cleaning in Global Healthcare Settings | HAI
| CDC
During a review of an online article from CDC titled Linen and laundry Management reviewed 5/4/2023,
indicated never carry soiled linen against the body, always place in a designated container and do not
transport soiled linen by hand outside the specific patient care area from where it was removed.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 17 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0881
Implement a program that monitors antibiotic use.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review the facility failed to implement their antibiotic stewardship program (measures
used by the facility to ensure antibiotics [drug to treat infection] are used only when necessary and
appropriate) on one of two sampled residents (Resident 26) by prescribing an antibiotic without meeting the
criteria of their protocol (checklist or guide to initiate antibiotic) for urinary tract infection([UTI] infection in
the urine).
Residents Affected - Few
This failure had the potential to put Resident 26 at risk for antibiotic resistance (not effective to treat
infection) and inappropriate use of antibiotic.
Findings:
During a review of Resident 26's admission Record (Face Sheet), indicated Resident 26 was admitted on
[DATE] with diagnoses including schizophrenia ( mental illness that affects how a person thinks, feels and
behaves), transient ischemic attack(occurs when the blood supply to a part of the brain is briefly
interrupted), benign prostatic hyperplasia ([BPH] enlarged prostate) and acute kidney failure(kidneys are no
longer able to adequately remove waste from the blood and control the level of fluid in the body).
During a review of Resident 26's Minimum Data Set ([MDS] standardized assessment and screening tool)
dated 11/8/2023, the MDS indicated Resident 26 had severely impaired cognition (person had trouble
remembering things, making decisions, concentrating, or learning) and required supervision with transfer,
bed mobility, and toileting.
During a review of Resident 26's Nurses Progress Notes dated 11/27/2023, at 1:16 p.m., indicated
Resident 26 was transferred to general acute care hospital (GACH) via 911 because of altered mental
status (change level of consciousness, behavior, mood or alertness).
During a review of Resident 26's Nurses Progress Notes dated 11/27/2023 timed at 6:40 p.m., indicated
Resident 26 returned to the facility in a stable condition and no complaint of dysuria (painful urination).
During a review of Resident 26's Nurses Progress Notes dated 11/27/2023, at 10:24 p.m. indicated
Cephalexin (antibiotic) 500 milligrams([mgs] unit of measurement) every six hours for 10 days was ordered
from GACH and the facility's physician ordered to continue Cephalexin 500 mgs. twice a day for 7 days. The
Nurses Progress Notes indicated Resident 26 was exhibiting swelling, or tenderness of testes (male
organ), or prostate (gland that produces some of the fluid) with a diagnosis of BPH.
During a review of Resident 26's Laboratory Results, the laboratory results indicated no urinalysis (urine
test to check the appearance, concentration, or content) or urine culture and sensitivity (urine test that can
identify the bacteria causing the infection) was sent to the laboratory to rule out (confirm) UTI.
During a review of Resident 26's Physician Order, the Physician Order indicated Cephalexin (antibiotic) oral
tablet 500 mgs. one tablet one time only for UTI until 11/27/2023 11:59 p.m. initial dose taken from
emergency kit and then one tablet by mouth two times a day for UTI for 7 days.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 18 of 19
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055531
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/30/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beachside Post Acute
22520 Maple Avenue
Torrance, CA 90505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0881
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
During a review of Resident 26's Medication Administration Record (MAR), the MAR indicated the Resident
26 received Cephalexin oral tablet 500 mgs. on 11/27/2023 at 11:38 p.m., 11/28/2023 at 9:00 a.m. and 5:00
p.m. and 11/29/2023 at 9:00 a.m.
During a concurrent interview and record review on 11/29/2023, at 3:01 p.m. with Infection Preventionist
Nurse (IPN), IPN stated the facility used McGeer Criteria (guide used to initiate antibiotic) for protocol and
Resident 26 used of antibiotic did not meet the criteria for antibiotic. IPN stated Resident 26 came back
from GACH with diagnosis of UTI but there was no urine test done in the hospital to confirm resident's
diagnosis of UTI or complaint of any pain or fever. IPN stated GACH did not do any urine tests before
initiating the antibiotic and according to their protocol Resident 26 should have two criteria before initiating
an antibiotic for UTI. IPN stated Resident 26 would be at risk for developing resistant organisms and could
have potential side effect from the use of antibiotic.
During an interview on 11/30/2023, at 12:44 p.m. with the Director of Nursing (DON), the DON stated the
facility should ensure the residents' usage of antibiotic would meet the McGeer Criteria because residents
could develop multi-drug resistant organism ([MDRO] germ that is resistant to many antibiotics and can be
difficult to treat) and could be considered unnecessary medication.
During a review of facility's job description of an Infection Preventionist revised 10/2020, the job description
indicated the Infection Preventionist will review, summarize and report data related to infection prevention
and control initiatives including antibiotic stewardship, immunization programs, outbreaks and healthcare
acquired infection.
During a review of facility's policy and procedure (P&P) titled Antibiotic Stewardship revised 12/2016, the
P&P indicated antibiotics will be prescribed and administered to residents under the guidance of the
facility's antibiotic stewardship program. The P&P indicated the purpose of facility's antibiotic stewardship
program is to monitor the use of antibiotics in the facility.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055531
If continuation sheet
Page 19 of 19
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Back to topCitations
10 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
F803 - Menus and nutritional adequacy
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F881 - Infection prevention and control program
Implement a program that monitors antibiotic use.
FAQ · About this visit
Common questions about this visit
What happened during the November 30, 2023 survey of BEACHSIDE POST ACUTE?
This was a inspection survey of BEACHSIDE POST ACUTE on November 30, 2023. The surveyor cited 10 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at BEACHSIDE POST ACUTE on November 30, 2023?
Yes, 10 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.